Provider Demographics
NPI:1407425135
Name:BLACKWELL, TAYLOR K (APN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:K
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:K
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TAYLOR RUPP
Mailing Address - Street 1:8440 BLACK WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-3103
Mailing Address - Country:US
Mailing Address - Phone:601-604-9782
Mailing Address - Fax:
Practice Address - Street 1:207 SPEARS AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3840
Practice Address - Country:US
Practice Address - Phone:423-756-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29613363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care